Provider Demographics
NPI:1356855423
Name:LUQUE, JENNIFER CATHERINE (MGC, LCGC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:LUQUE
Suffix:
Gender:F
Credentials:MGC, LCGC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CATHERINE
Other - Last Name:GAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MGC,CGC
Mailing Address - Street 1:50 NAVARRE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1023
Mailing Address - Country:US
Mailing Address - Phone:585-208-0504
Mailing Address - Fax:
Practice Address - Street 1:5230 S STATE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-7936
Practice Address - Country:US
Practice Address - Phone:855-293-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000789170300000X, 170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS